Diploma of Medical Ultrasonography (DMU) (Cardiac) Syllabus

Transcription

1 1 Diplma f Medical Ultrasngraphy (DMU) (Cardiac) Syllabus

2 2 INTRODUCTION This syllabus is divided int tw parts. Part 1 frms the fundatin fr Part 2. Part 2 cntinues with the acquisitin f knwledge and cncentrates n the acquisitin f skills. i. Philsphy/Perspective Diagnstic ultrasund is firmly established in medical practice. Ultrasund facilitates decisins regarding patient management and the sngrapher plays a significant rle in the diagnstic team. The training and assessment prcesses need t reflect the respnsibilities required f the sngrapher. ii. Thery And Training As health care prfessinals, the sngrapher s rle is t perfrm imaging t a high standard and t prvide accurate infrmatin t aid in the crrect management f the patient. Vital t the perfrmance f a high standard f practice are several factrs including: The assimilatin f factual knwledge and understanding f relevant physical principles f ultrasund, instrumentatin, anatmy, physilgy, pathlgy and, where applicable, therapeutic interventin Acquisitin and understanding f the required technical skills Acquisitin and apprpriate use f high-level ral and written cmmunicatin skills Acquisitin f interpersnal skills necessary fr the sngrapher t functin in a prfessinal, cmpetent, caring and cmpassinate manner Clinical supervisin is prvided by the practice in which the sngrapher is wrking. It is recgnised that sme trainees may nt be expsed t the brad range f ultrasund applicatins in ne institutin. Where there are lcal limitatins, experience shuld be sught elsewhere. Participatin in day-t-day reprting, clinical cnferences and scientific meetings is advised. Emphasis is placed n current knwledge and skills. A cmmitment t cntinuing educatin is a prfessinal respnsibility. iii. Respnsibilities In the delivery f a high quality prfessinal service the respnsibilities f the sngrapher include: Clear cmmunicatin with the patient and ther medical staff Preparatin f the patient fr the examinatin An ability t btain infrmed cnsent Cnfidentiality with patient infrmatin Care and cmfrt f the patient during the examinatin Familiarity with emergency prcedures Strict adherence t infectin cntrl practice and knwledge f current standards Safe wrk practices in accrdance with current standards f ccupatinal health and safety cnsideratins Knwledge f bieffects Care and maintenance f equipment Acquisitin f apprpriate infrmatin t be presented t the medical practitiner fr cnsideratin and reprting Awareness f prfessinal, legal and ethical aspects f sngraphic practice Sensitivity t cultural differences Quality cntrl f equipment and practical and administrative details A cmmitment t cntinuing educatin ASUM plicies, statements and clinical prtcls are applicable where apprpriate in the abve pints.

3 3 iv. Overview Of The DMU (Cardiac) The DMU (Cardiac) is designed t assess the candidate s knwledge and cmpetencies in: Tw-dimensinal (2D) and mtin mde (M-mde) techniques f the nrmal and abnrmal adult heart, including measurements, haemdynamic evaluatin and limitatins Spectral (including DTI Dppler Tissue Imaging) and clur Dppler techniques f the nrmal and abnrmal heart, including qualitative and quantitative haemdynamic evaluatin, measurements and limitatins. In rder t achieve and demnstrate these skills, the sngrapher must: Have knwledge f nrmal and abnrmal cardiac anatmy, including grss anatmy, spatial relatins, related vasculature, crss-sectinal anatmy, cardiac embrylgy and maldevelpment f the human heart Have knwledge and understanding f cardivascular physilgy, including haemdynamics, electrcardigraphy and the cnductin system, and basic cardiac pharmaclgy Have knwledge and understanding f cardiac pathlgy and pathphysilgy in a wide range f acquired and cngenital heart disease Have knwledge f cardiac surgical and interventinal prcedures, including valve replacement and repair, crnary artery bypass grafting, cngenital surgical repair and balln valvulplasty Have a demnstrated knwledge f the clinical details and assciated sngraphic findings as per clinical requests fr an echcardigram Have knwledge f theretical and applied physical principles f ultrasund and instrumentatin Have knwledge f theretical and applied principles f Dppler ultrasund and instrumentatin Be able t demnstrate apprpriate scanning techniques and acquisitin f sngraphic infrmatin, including apprpriate measurements and limitatins f these measurements Be able t interpret sngraphic findings with an analytical and critical apprach Be able t present sngraphic images in a lgical and methdical manner In additin, cardiac sngraphers are required t have a basic knwledge and understanding f the clinical indicatins, technique and limitatins f: Other echcardigraphic mdalities such as stress echcardigraphy, transesphageal echcardigraphy, intraperative echcardigraphy and paediatric echcardigraphy New and evlving technlgies such as cntrast echcardigraphy, intravascular techniques, 3D echcardigraphy Cmplementary diagnstic cardiac prcedures, including cardiac catheterizatin, ECG, Stress ECG, plain X-ray, CT, MRI, and radinuclide imaging The DMU (Cardiac) is als designed t assess the candidate s knwledge f ther imprtant aspects f sngraphic practice such as: Prfessinal, legal and ethical aspects f sngraphic practice Quality cntrl principles and practices Safe wrk principles and practices

4 4 PART 1 DMU (CARDIAC) SYLLABUS a. Cardiac And Related Anatmy Within this area, candidates are required t have knwledge f the fllwing: Basic anatmical terminlgy and bdy regins Cardiac size, shape and external features including: psitin f the heart within the thrax cardiac surfaces and sulci cardiac base, apex, surfaces and brders cardiac valve relatins and surface anatmy fibrus skeletn mtin f heart during the cardiac cycle Anatmy f the cardiac chambers and related septa, including: right atrium left atrium interatrial septum left ventricle right ventricle interventricular septum Anatmy f valves and related apparatus including: structure and functin f the atriventricular valves: tricuspid valve and supprting apparatus mitral valve and supprting apparatus structure and functin f the semilunar valves: artic valve pulmnary valve Arterial and venus systems including: structure f bld vessels functin f arteries and veins arta: segments and branches pulmnary trunk crnary arteries (rigin, distributin and functin) cardiac veins (distributin, drainage and functin) superir vena cava inferir vena cava Cnductin system f the heart including the lcatin and functin f: sinatrial (SA) nde interndal (interatrial) pathways atriventricular (AV) nde Bundle f His Bundle branches Purkinji fibres Layers f the heart: pericardium epicardium mycardium endcardium Cardiac muscle structure

5 5 Innervatin f the heart and vessels including: sympathetic fibres parasympathetic fibres sensry fibres b. Cardiac Embrylgy Within this area, candidates are required t have a basic knwledge f the fllwing: Embrylgical develpment and frmatin f the cardivascular system, including: primitive vascular tube sinus vensus cardiac lp cardiac septa atriventricular and semilunar valves the artic arch system the systemic venus system adult derivatives f fetal structures Fetal and nenatal circulatins: fetal circulatin circulatin changes at birth (including mechanisms fr changes) Abnrmalities f develpment, including abnrmalities f the fllwing: cardiac septatin the atriventricular canal atriventricular and semilunar valves the truncus and cnus the great arteries venus drainage persistent fetal circulatin c. Cardiac Physilgy Within this area, candidates are required t have knwledge f the fllwing: Electrphysilgy f the Heart including: the cnductin system actin ptentials and excitatin-cntractin cupling The Electrcardigram including: the nrmal 12 lead electrcardigram (ECG) abnrmalities f the ECG cmplex abnrmalities f rhythm abnrmal cnductin pre-excitatin syndrmes cardiac pacemakers Mechanical events including: Frank-Starling Law Valve mtin and the relatinship f mtin t the cardiac cycle Phases f the Cardiac Cycle including: atrial systle isvlumic cntractin ventricular ejectin isvlumic relaxatin passive filling phase

6 6 diastasis relatinship between these phases and electrical and mechanical events Cardiac Output and its Cntrl including: definitin f cardiac utput methds f calculating the cardiac utput cntrl f cardiac utput factrs affecting cardiac utput Intracardiac pressures and pressure wavefrms including: nrmal intracardiac pressures pressure wavefrms as seen at cardiac catheterisatin Systemic versus pulmnary circulatin including: cmpnents f these circulatins pressures within each circulatin xygen saturatins within each circulatin Crnary circulatin, including: crnary artery circulatin crnary venus return Variables that alter cardiac physilgy including: exercise psitinal changes respiratin Valsalva maneuvre Cardiac auscultatin including: sites fr auscultatin mechanism and timing f the: first heart sund (S1) secnd heart sund (S2) third heart sund (S3) furth heart sund (S4) - d. PATHOLOGY Within this area, candidates are required t have knwledge f the fllwing: Basic cncepts f general pathlgy including: cell injury and adaptatin inflammatin and repair fluid and haemdynamic derangements athersclersis, thrmbsis, emblism and infarctin genetic disrders disrders f immunity neplasia Symptms f cardiac disease prcesses including: dyspnea chest pain syncpe/ presyncpe fever Physical signs f cardiac disease prcesses including:

7 7 clubbing cyansis (peripheral versus central) edema abnrmal heart sunds and heart murmurs (including causes) elevatin f the JVP Cardiac diseases and disease prcesses including a basic knwledge f the aetilgy, pathphysilgy, clinical findings and cmplicatins f the fllwing cardiac diseases (NOTE: candidates are expected t acquire a basic knwledge f these areas, as a mre in depth knwledge will be required fr the DMU( Cardiac) Part 2 syllabus): ischaemic heart disease valvular heart disease diseases f the arta cardimypathies (hypertrphic, restrictive and dilated) pericardial disease systemic and pulmnary hypertensin cardiac tumurs infective endcarditis Cardiac Disease due t systemic illness including a basic knwledge f the disease prcess and the assciated cardiac invlvement f the fllwing systemic diseases: rheumatic disease systemic lupus erythematsus amylidsis sarcidsis carcinid disease Cngenital heart disease including a basic knwledge f the definitin and diagnstic criteria, embrylgical maldevelpment, pathphysilgy and assciated cardiac lesins f the fllwing: valvular, subvalvular and supravalvular stensis atrial septal defects (secundum, primum, sinus vensus, crnary sinus) ventricular septal defects (membranus, muscular) endcardial cushin defect (A-V canal defect) patent ductus arterisus carctatin f the arta Ebstein s anmaly Tetralgy f Fallt Eisenmenger s syndrme transpsitin f the great arteries (dextr versus lev) truncus arterisus anmalus pulmnary venus drainage (ttal and partial) A basic knwledge f the definitin f the echcardigraphic presentatin f syndrmes cmmnly assciated with cngenital heart disease (including assciated cngenital heart lesins) such as: DiGerge sequence (e.g. artic arch anmalies) Dwn syndrme (e.g. atriventricular canal defect, VSD, Tetralgy f Fallt) Ehlers-Danls syndrme (e.g. artic rt dilatatin, mitral and tricuspid valve prlapse) fetal rubella syndrme (e.g. patent ductus arterisus) Friedreich s ataxia (e.g. cardimypathy) Gldenhar syndrme (e.g. ventricular septal defect)

8 8 Hlt-Oram syndrme (e.g. atrial septal defect) Marfan syndrme (e.g. ascending arta dilatatin, mitral and tricuspid valve prlapse) muscular dystrphy (Duchenne type) (e.g. cardimypathy) Nnan syndrme (e.g. pulmnary valve stensis) Tuberus sclersis (e.g. rhabdmymas) Turner syndrme (e.g. carctatin f the arta) Williams syndrme (e.g. supravalvular artic stensis) e. Cardiac Pharmaclgy Within this area, candidates are required t have a basic knwledge f the types, principal actins and majr indicatins f the fllwing cardivascular drugs: intrpic / chrntrpic drugs antiarrhythmic drugs antihypertensive drugs antianginal agents / vasdilatrs anticagulant, thrmblytic, lipid-lwering and antiplatelet drugs diuretics drugs used t maintain/clse a patent ductus arterisus (PDA) NOTE: It is each candidate s respnsibility t ensure that they have cvered all the areas in this syllabus. PART 2 DMU (CARDIAC) SYLLABUS a. Technique: General Cnsideratins The sngrapher will be expected t attain cmpetence in the perfrmance and interpretatin f diagnstic ultrasund examinatins. Alng with a review f relevant Part I material, emphasis will be placed n applicatin f this knwledge and its integratin with the develpment f technical skills, image interpretatin and patient care. This will invlve reviewing anatmy and pathlgy and understanding the technical requirements necessary t prduce ultrasund images that display nrmal and abnrmal anatmy. Fr any examinatin, the sngrapher will be expected t: Understand the clinical indicatin fr the examinatin Assess the suitability f ultrasund t answer a particular questin and recgnise any limitatins presented by: patient cnditin/habitus equipment available persnal skills Explain the prcedure t the patient Be aware f the needs f the patient during the examinatin and maintain a gd level f cmmunicatin with the patient thrughut the prcedure t ensure that patient needs are met thrughut the prcedure Select the apprpriate ECG lead and ensure crrect ECG lead placement (lead II shuld rutinely be used). Optimisatin f the ECG signal thrughut the echcardigram (shwing an upright P wave) t ensure crrect digital capture ccurs Select apprpriate transducer and transducer frequency Optimise technical factrs in rder t btain best pssible image quality Recgnise artifacts and their causes Optimise image cntrls t preserve and enhance image detail Systematically survey cardiac and adjacent structures with attentin t: chamber and great vessel dimensins

9 9 ventricular functin intracardiac valve mrphlgy and functin intracardiac flw dynamics Recgnise and describe the sngraphic appearances f nrmal anatmy, physilgy and pathlgy Perfrm relevant and pertinent 2-D, M-mde and Dppler measurements Extend the examinatin t ther areas as may be indicated by findings during the examinatin Select suitable images t recrd relevant anatmy and pathlgy Recrd M-mde, tw dimensinal and Dppler studies ensuring that an apprpriate number f images are recrded t fully demnstrate all nrmal and abnrmal anatmy and haemdynamic infrmatin Demnstrate a high level f prficiency in the use f the nn-imaging CW Dppler prbe (Pedff prbe). This includes the crrect and apprpriate use and applicatin f this prbe, the advantages f using this prbe, and the limitatins f this prbe. Understand clinical measurements in cmmn usage in echcardigraphy Be aware f specialised imaging techniques relevant t echcardigraphy, e.g. transesphageal, stress ech, cntrast ech Present, explain and discuss the sngraphic infrmatin fr reprting Cmply with ASUM s Plicy n Ultrasund Safety Label recrded images apprpriately Use equipment safely b. Techniques Within this area, candidates are required t have a detailed knwledge f the: 2-D Examinatin including: acustic windws (bth standard and additinal acustic windws, s as t ensure that all pathlgy is fully demnstrated and interrgated) imaging planes and knwledge f the structures visualized in each echcardigraphic view echcardigraphic views including patient psitin, transducer psitin and rtatin, image rientatin, structures identified ptimisatin f 2D imaging cntrls (including frequency, depth, zm functins, pre-prcessing, verall gain, TGC, dynamic range, persistence, edge enhancement, pst-prcessing, B-clur in 2D imaging) 2D imaging artifacts (aetilgy, echcardigraphic appearance, principles f physics f hw and why the artifact ccurs, techniques used t crrect/avid the artifact) M-mde measurement methdlgy structures interrgated including imaging plane, cursr psitin, structures transected, mtin f structures thrughut the cardiac cycle advantages and disadvantages f M-mde imaging as cmpared t 2D imaging Spectral Dppler examinatin including imaging planes, nrmal spectral display, spectral Dppler machine cntrls ptimisatin f Spectral Dppler machine cntrls (including gain, velcity scale, baseline, filters, sweep speed, sample vlume psitin, sample vlume size) Pulse-wave (PW) Dppler versus Cntinuus-wave (CW) Dppler, including the applicatin f PW and CW Dppler in cardiac pathlgy: Spectral Dppler presentatins f cardiac pathlgy

10 10 Clur flw Dppler examinatin including imaging planes and nrmal clur flw Dppler patterns Recgnitin f spectral and clur Dppler artifacts (hw and why they the artifact ccurs, techniques used t crrect/avid the artifact) c. Dppler Haemdynamic Assessment: Principles, Frmulae and Calculatins Within this area, candidates are required t have knwledge f the: Principles f Bld Flw including: characteristics f bld flw prperties f bld factrs that affect bld flw types f bld flw (laminar flw, turbulent flw) Principles f the Dppler Effect including: The Dppler effect The Dppler equatin (including each cmpnent f this equatin) Pressure Gradient Calculatins including: simplified Bernulli equatin (including understanding the cmpnents f the Bernulli equatin, the assumptins f the simplified Bernulli equatin, when the Bernulli equatin needs t be mdified) maximum instantaneus pressure gradients mean pressure gradients limitatins f pressure gradient calculatins Vlume Flw Calculatins including: strke vlume calculatins cardiac utput calculatins QP:QS Shunt calculatins limitatins t vlume flw calculatins Valve Area Calculatins including: pressure half-time and deceleratin time methds cntinuity equatin methd (assumptins f the cntinuity equatin, applicatins and limitatins) prximal isvelcity surface area (PISA) methd limitatins f valve area calculatins Regurgitatin Quantificatin including: regurgitant vlumes and Regurgitant fractins, effective Regurgitant rifice area Prximal isvelcity surface area (PISA) methd vena-cntracta technique fr the assessment f the severity f regurgitant lesins jet height/lvot height ratin in the assessment f the severity f artic regurgitatin jet area ratis limitatins t these methds Intracardiac Pressure Calculatins including estimatin f: right ventricular and pulmnary systlic pressure pulmnary artery end-diastlic pressure pulmnary artery mean pressure right atrial pressure (2D imaging f the IVC) left ventricular end-diastlic pressure left atrial pressure Limitatins f Dppler techniques in the estimatin f intracardiac pressures d. Assessment f Left Ventricular Functin

11 11 Within this area, candidates are required t have knwledge f the: Assessment f Left Ventricular Systlic Functin: M-Mde methds and relevant frmulae Tw-dimensinal (2-D) methds and relevant frmulae, including the mdified Simpsn s Biplane methd f quantitating LV size and LV systlic functin Dppler methds and relevant frmulae Limitatins f 2D, M-mde and Dppler methds NOTE: a candidate must demnstrate an understanding and crrect applicatin f the reference ranges fr nrmal and abnrmal cardiac chamber sizes (including referenced t patient height and bdy surface area) and LV systlic functin, as per the American Sciety f Echcardigraphy (ASE) recmmendatins (see Part 2 references). Candidates must be aware f, and understand the current ASE recmmendatins fr chamber quantificatin. Assessment f Left Ventricular Diastlic Functin including: clinical indicatins fr diastlic functin assessment M-mde indicatrs f increased LV end-diastlic pressure clur M-mde use in the assessment f LV diastlic functin, particularly in the assessment f pseudnrmal diastlic dysfunctin Dppler techniques used in assessing diastlic functin Dppler Tissue Imaging (DTI r TDI) use in the assessment f LV diastlic functin, including applicatins, nrmal ranges, identificatin f abnrmal values, use f DTI in cnstrictin, limitatins f DTI abnrmal diastlic filling prfiles significance f left ventricular systlic functin and patient sex and age in the assessment f diastlic functin limitatins f M-mde and Dppler assessment f left ventricular diastlic functin e. Chamber Quantificatin It is expected that candidates will refer t the American Sciety f Echcardigraphy with regards t chamber quantificatin and right heart assessment. Fr this sectin f the syllabus refer t the recmmended reading list. Within this area, candidates are required t have a detailed and thrugh knwledge f: Assessment f Left Ventricular chamber size and wall thickness M-mde and 2D measurements (including Simpsn s biplane vlumes) applicatins and limitatins f these techniques reference ranges fr nrmal and abnrmal Left Ventricular size, including crrectin fr bdy surface area (BSA), height and gender fr bth M-mde and 2D methds (including Simpsn s biplane vlumes) calculatin f Left ventricular mass frm Left Ventricular M-mde measurements, including reference ranges fr nrmal and abnrmal Left Ventricular wall thickness assessment f Right Ventricular size and wall thickness M-mde and 2D methds (basal, mid-cavity and lngitudinal dimensins as measured frm the Apical 4 chamber view). applicatins and limitatins f these techniques reference ranges fr nrmal and abnrmal Right Ventricular size assessment f Right Ventricular systlic functin (example fractinal area change, tricuspid annular excursin n 2D imaging, tricuspid annular DTI) reference ranges fr nrmal and abnrmal RV systlic functin Assessment f the Left and Right Ventricular utflw tracts (LVOT and RVOT) and great arteries (arta and pulmnary artery): 2D measurements f LVOT and RVOT diameters

12 12 applicatins f the 2D measurements f LVOT and RVOT diameters in interrgatin f nrmal and pathlgical cardiac haemdynamics 2D measurements f the pulmnary artery (PA) 2D measurements f the segments f the arta (A) including trans-sinus diameter, sintubular junctin, ascending A, descending A and artic arch applicatins f the 2D measurements f the segments f the arta in nrmal and pathlgical situatins reference ranges fr LVOT, RVOT, A and PA measurements (including crrectin f the Arta fr BSA and height) limitatins f the 2D measurements f the LVOT, RVOT, A and PA Assessment f the Inferir Vena Cava (IVC) M-mde technique f assessing IVC size and inspiratry respnse 2D measurement f the IVC frm the subcstal shrt axis view 2D evaluatin f the inspiratry respnse f the IVC in the assessment f right atrial pressure reference ranges fr the assessment f IVC size and inspiratry respnse applicatins and limitatins f these techniques Assessment f the Left Atrium (LA) and Right Atrium (RA) M-mde and 2D measurements f the LA size (including LA crss-sectinal area and LA biplane vlumes) reference ranges fr nrmal and abnrmal left atrial size, including crrectin fr bdy surface area (BSA) 2D measurements f RA size applicatins and limitatins f the measurement f LA and RA size f. Ischemic Heart Disease Within this area, candidates are required t have knwledge f: Wall mtin abnrmalities including: aetilgy f reginal wall mtin abnrmalities echcardigraphic criteria f wall mtin scring divisin f the left ventricle int the traditinal 16 segment mdel, and als understanding and knwledge f the new 17 segment mdel, as per the ASE 2005 recmmendatins (see Part 2 Reading List fr details) echcardigraphic planes used t visualise bth the 16 and 17 segment mdels as per the ASE 2005 recmmendatins (see Part 2 Reading List fr details) crnary artery supply t the segments f the left ventricle as well as t the right ventricle relatinship between crnary artery distributin, ECG leads and echcardigraphic views Echcardigraphic assessment f the secndary cmplicatins f the mycardial infarctin including: intraventricular thrmbus true ventricular aneurysms false r pseud ventricular aneurysm papillary muscle dysfunctin / rupture ventricular septal rupture right ventricular infarctin pericarditis/pericardial effusin g. Valvular Heart Disease Within this area, candidates are required t have knwledge f: Native Valve Disease including: aetilgy f valve disease

13 13 2-D, M-mde and Dppler echcardigraphic examinatin, techniques and findings semiquantitative and quantitative measurements used in the assessment f severity f valve lesins (including methdlgy, reference ranges fr the quantitatin f severity f bth stentic and regurgitant valve disease, limitatins and advantages f each technique) criteria emplyed fr determining grades f severity f valve lesins - including an understanding f the ASE recmmendatins fr evaluatin f the severity f native valvular regurgitatin with tw dimensinal and Dppler Echcardigraphy (see part II references fr details). Spectral Dppler indirect signs f significant valvular regurgitatin Prsthetic Heart Valves including: knwledge f the different types f prsthetic valves (mechanical and biprsthetic) understanding the imprtance f an early pst-perative baseline study fr prsthetic valves understanding the imprtance f valve psitin, type and size with regard t nrmal Dppler values 2-D, M-mde and Dppler echcardigraphic assessment f prsthetic valves, including artifacts cmmnly encuntered, limitatins f transthracic echcardigraphy, and the rle f transesphageal echcardigraphy echcardigraphic assessment f prsthetic valve dysfunctin criteria emplyed fr determining nrmal and abnrmal prsthetic valve functin as per the ASE guidelines n echcardigraphic assessment f prsthetic valves h. Cardimypathies Within this area, candidates are required t have knwledge f the aetilgy, 2-D, M-mde and Dppler echcardigraphic examinatin and findings f: Dilated cardimypathies Hypertrphic cardimypathies Restrictive/Infiltrative cardimypathies i. Systemic And Pulmnary Hypertensive Heart Disease Within this area, candidates are required t have knwledge f the aetilgy, 2-D, M-mde and Dppler echcardigraphic examinatin and findings f: Systemic hypertensin Pulmnary hypertensin j. Diseases Of The Arta Artic rt dilatatin Artic dissectin Sinus f valsalva aneurysm Classificatin f artic dissectins: DeBakey and Stanfrd classificatins Rle f transesphageal echcardigraphy in the assessment f artic dissectins k. Pericardial Disease Within this area, candidates are required t have knwledge f the aetilgies, 2-D, M-mde and Dppler echcardigraphic examinatin and findings f: Pericardial effusin Cardiac tampnade Cnstrictive pericarditis

14 14 Candidates are als required t have knwledge f the echcardigraphic differentiatin between pericardial effusins and the fllwing: Left pleural effusin Epicardial fat pads Hiatus hernia Descending artic aneurysm Left ventricular pseudaneurysm l. Cardiac Masses Within this area, candidates are required t have knwledge f the types and 2-D, M-mde and Dppler echcardigraphic examinatin, techniques and findings f: Cardiac tumurs Thrmbus Candidates are als required t have knwledge f the types and 2-D, M-mde and Dppler echcardigraphic examinatin, techniques and findings f: Endcarditis Candidates are als required t have knwledge f cmmnly encuntered artifacts, causes f artifacts and the echcardigraphic recgnitin f artifacts. m. Cardiac Diseases Due t Systemic Illness Within this area, candidates are required t have knwledge f the basic pathlgical features, assciated with cardiac invlvement and the echcardigraphic findings f the fllwing systemic diseases: Hyperesinphilia Cnnective tissue disrders (Marfans and Ehlers-Danls) Phechrmcytma Rheumatid arthritis Rheumatic fever Sarcidsis Systemic lupus erythematsus Amylidsis Carcinid Haemchrmatsis n. Cngenital Heart Disease Within this area, candidates are required t have knwledge f the lesins, and the 2-D, M- mde and Dppler echcardigraphic examinatin, techniques and findings f: Valvular stensis Atrial septal defects (secundum, primum, sinus vensus, crnary sinus) Ventricular septal defects (membraneus, muscular) Endcardial cushin defect (A-V canal defect) Transpsitin f the great arteries (dextr versus lev) Carctatin f the arta Ebstein s anmaly Tetralgy f Fallt Eisenmenger s syndrme Patent Ductus Arterisus Candidates are als required t have knwledge f palliative and crrective surgical prcedures such as: Fntan Mustard

15 15 Pulmnary artery band Rastelli Senning Arterial Switch Candidates are als required t have knwledge f syndrmes cmmnly assciated with cngenital heart disease (including assciated cngenital heart lesins) such as: DiGerge sequence (e.g. artic arch anmalies) Dwn syndrme (e.g. atriventricular canal defect) Ehlers-Danls syndrme (e.g. artic rt dilatatin) Fetal rubella syndrme (e.g. patent ductus arterisus) Friedreich s ataxia (e.g. cardimypathy) Gldenhar syndrme (e.g. ventricular septal defect) Hlt-Oram syndrme (e.g. atrial septal defect) Muscular dystrphy (Duchenne type) (e.g. cardimypathy) Nnan syndrme (e.g. pulmnary valve stensis) Tuberus sclersis (e.g. rhabdmymas) Turner syndrme (e.g. carctatin f the arta) William syndrme (e.g. supravalvular artic stensis). Other Echcardigraphic Mdalities Within this area, candidates are required t have a basic knwledge f the clinical applicatin f the fllwing imaging techniques, including the indicatins, cntraindicatins, limitatins, advantages, disadvantage, techniques and interpretatin f test results fr: Stress Echcardigraphy including: exercise Echcardigraphy: pharmaclgical (Dbutamine) Stress Echcardigraphy Transesphageal Echcardigraphy p. New And Evlving Technlgies Within this area, candidates are required t have a basic knwledge f the clinical applicatins f: Cntrast echcardigraphy Intravascular techniques 3D echcardigraphy Fetal echcardigraphy q. Prfessinal, Legal and Ethical Aspects f Sngraphic Practice The rle f the sngrapher is diverse and cmplex and s DMU candidates are required t have an understanding f their respnsibilities t the: patient emplyer regulating bdies Candidates must als understand and adpt practices that cnfrm t the standards f their prfessin and have due cnsideratin fr the legal and ethical issues which regulate their actins as a health care prfessinal. Sngraphers must be aware f their legal respnsibilities and f ethical issues that may ccur during their practice as a sngrapher. The candidate is expected t have an understanding abut a range f legal issues including: cnsent verbal written

16 16 implied cmpetence t give cnsent patient cnfidentiality recrd keeping maintaining cnfidentiality strage f recrds a sngrapher s legal respnsibilities Sngraphers must be aware f: published standards f practice the prcess f sngrapher accreditatin the value f membership t apprpriate prfessinal bdies The candidate is als expected t have a gd knwledge f these wrk place issues: wrkplace health and safety including ergnmics emergency prcedures infectin cntrl plicies prcedures quality cntrl f equipment administrative prcesses indemnity insurance The candidate must als have an understanding f the fllwing ethical aspects f sngraphy: basic biethical principles and hw they apply t sngraphy autnmy nn-malefiecence beneficience justice veracity hw t reslve ethical dilemmas and cnflict the relevance f biethics in the practice f sngraphy and in particular in: bstetrics and gynaeclgy the use f new technlgies In rder t be able t critically analyse infrmatin and understand their respnsibilities yu will need t: read widely frm relevant publicatins attend cnferences and seminars participate in cntinuing educatin prgrams NOTE: It is each candidate s respnsibility t ensure that they have cvered all the areas in this syllabus..